What does it mean to be ‘Holistic’?

The content of this blog was first published as the ‘Holistic’ dimension in our old website in 2016. The ‘dimensions’ idea came from our former chair, retired GP Dr William House. It culminated from his years of exploration of what holism meant to him. Dr House recognised that we, as ‘holistic’ practitioners, should aspire to be:

• Balanced
• Community Minded
• Compassionate
• Connected
• Empowered
• Integrated
• Intuitive
• Meaning – full
• Resilient
• Self-caring
• Wise

And of course Holistic. The rest of these dimensions are being integrated into a new course on Holism which we will be offering soon, and being made into a series of blogs.

Holistic

To see a World in a Grain of Sand
And a Heaven in a Wild Flower
Hold Infinity in the palm of your hand
And Eternity in an hour

From Auguries of Innocence   William Blake

 

If we are to do our part in making better the care of others and ourselves, our greatest need is not for competing scientific claims, nor for arguments about which therapy, nor for which research evidence is best. Though these all matter, they are about making use of the world around us. But we are the world around us. So long as we are us and the rest are them or that, we are destined to make a mess. So we must pay attention to how we engage with the world. We must seek …

… fluency in the language that speaks of the qualities of the human.

By using these qualities as our way into the complexity, we have a chance of achieving the wider, deeper and dynamic view – a holistic view. In this way, we will make less of a mess, perhaps we will even leave some beauty behind us. It’s the knower we need to better understand, not so much the known.

These human qualities become the dimensions of being holistic in our understanding of ourselves, of one another, of the world

around us, and in the case of practitioners, of our practice.

We cannot define the word holistic beyond describing it as a way of understanding the world. It defies precise definition without loss of meaning. But we hope to reveal its full meaning in the mirror of those who care.

The Qualities of the Human

Plus ça change, plus c’est la même chose.

(The more things change, the more they stay the same.)

In this section we look at the roots of the problems that advanced countries have in providing healthcare for their populations. At the same time, this begins to shine a light on the deep causes of much of our individual suffering. Looking for root causes is a vital part of the holistic view – whether it be the struggle of a whole nation or the struggle of one person.

Origins and problems with being human – understanding our roots

We are told that we are living in a time of rapid change. Of course, this is true in many ways, particularly the development of science and technology. But it is easy to be mesmerised by what is changing and to forget what stays the same. The fundamentals of human nature have changed little since our species left Africa about 125,000 years ago. We evolved to be uniquely intelligent, dependent on cohesive and cooperative social groups, and at the same time competitive, both as individuals and between groups.

An unavoidable and perpetual war exists between honour, virtue, and duty, the products of group selection, on one side, and selfishness, cowardice, and hypocrisy, the products of individual selection, on the other side.
In a constantly changing world, we need the flexibility that only imperfection provides.
Edward O. Wilson The Social Conquest of Earth (p 56 & 241)

Our selfish and greedy instincts, the ones we often label as vices, are older, more primal and harder to constrain; likewise, the often brutally competitive instincts of tribes. In contrast, the self-sacrificing parts of our human nature, that are key to the success of groups, are newer in evolutionary terms, and more fragile.

The necessary ‘imperfection’ that Wilson refers to requires a dynamic balance between the selfish and the self-sacrificing. We have to work harder to maintain that balance, to achieve the flexibility that enables us to collectively thrive in a changing world. Our problem in the 21st century is that, in many places, we have lost that balance. Our Western capitalist society privileges greed and selfishness. Even when plentiful material goods help to keep us peaceful, the accompanying fragmentation of communities and the grotesque inequalities in wealth produce illness and misery. Other societies have adopted a rigid moral framework that lacks flexibility and is liable to produce material deprivation and brutality. Both sorts of society (but especially the capitalist) contribute to environmental damage, perhaps the greatest long term risk to survival. Both sorts of society get us into a mess through ignoring our evolutionary heritage.

The UK National Health Service currently has an unsustainable mixture of these two failing systems. Through taking a holistic view, we stand a chance of understanding and producing answers.

The hunter-gatherer human

 

Tools for heroes

Most of our evolution was as hunter-gatherers, like the family group shown above. The Magdalenian period was just before the development of agriculture, so more than 100,000 years had already passed since we emerged from Africa as a distinct species of social hunter-gatherers. For millions of years before that, our forebears were accumulating the characteristics we now recognise as human. So we evolved to be hunter-gatherers.

Our modern lives have developed in a blink of the evolutionary eye. We are adapted to fulfill certain key roles essential to survival in prehistoric times: principally, the heroic hunter and defender, the nurturing parent and the community elder. The first two of these are the most ancient and the last is the most recent, the most fragile and the most likely to be neglected.

 

Language Matters – Holistic and Love

In our 21st century United Kingdom culture, the word holistic in the context of healthcare often means something to do with natural therapies and even beauty products. This is a misuse of the word.

If this word means having a wide and deep understanding of the world and our place in it, perhaps from unfamiliar angles, then many ‘natural’ therapies and products would not be ‘holistic’, whether beneficial or otherwise.

In order to speak and write with the power to communicate authentically about the complexity of health and suffering, we need a rich language and the word ‘holistic’ is a valuable part of that language. It is much more difficult to speak meaningfully about the human experience than it is to speak about material objects – cars, clothes, houses. This material world lends itself to measurement but we have come to trust numbers beyond their worthiness of trust. They can, and often do, give us a false sense of certainty. Nowhere is this more prevalent than in healthcare. Our holistic response is to rebuild our trust in using language to describe the ineffable. This is our challenge.

Another word that suffers is love. Like holistic it cannot be defined without loss of meaning, but it is a universal human experience. Both ‘holistic’ and ‘love’ denote a powerful sense of connection and perhaps belonging to, even being part of.  Few human beings can thrive without ‘being part of’. Yet both words have been commodified in our consumerist culture. This cheapens our language and makes communication even more difficult.

Holism (and its lack) may be easier to recognise than define. It is more readily communicated and perceived by stories, rather than data or abstract formulations. This presents problems: holistic mindsets are now becoming harder to access and maintain,  for our culture is now one that increasingly conceives and conveys in packages – food, fuel, news, entertainment, even thought is all likely to be coded, metered, monitored, measured or packed.

Dr David Zigmond, Words and Numbers, Servants or Masters? (Caveats for holistic healthcare Part 1). This article is illustrated with stories from his work as a general practitioner.

 

“World is crazier and more of it than we think,

Incorrigibly plural. I peel and portion 

A tangerine and spit the pips and feel

The drunkenness of things being various”

From Snow; Louis MacNeice

 

Social media as a means of communication seems to be substituting for conversation in many relationships. Communicating complex messages with the 140 characters of a tweet is a big challenge. It needs a fertile mind to capture subtleties of meaning on that scale, though it is possible with wit and imagination. For most of us, reduced text translates into reduced meaning.

We confine ourselves to telling our friends what we had for breakfast with a photo.

 

 

This is part of a much wider challenge which is mentioned in the community-minded and the connected dimensions.

In healthcare we need to reclaim a language that helps us to share the richness of human connection. Other (perhaps all) languages have words with similar meanings to the original meaning of holistic. For instance, German has gestalt, and Southern African speakers have ubuntu. The meaning of human life is central to health and suffering.

   

The crisis of language in healthcare

We are left with a crisis in our shared humanity. Not only do we have difficulty in keeping a healthy balance of our conflicting instincts as both individuals and social animals, but our Western culture is making it hard for us to nurture, through language, the social side of our nature.

Needs which lack a language adequate to their expression do not simply pass out of speech: they may cease to be felt….. Of all the needs I have mentioned the one which raises this problem of the adequacy of language in its acutest form is the need for fraternity, social solidarity, for civic belonging.

Michael Ignatieff (Canadian writer and academic), in his 1984 book, The Needs of Strangers (p138)

And the politicians pretend to wonder why the people do not engage with the public democratic institutions! The result is social fragmentation, dependency and socially determined illness, particularly addiction in all its forms.

Of course, this problem also very much affects the microcosm of the state: the UK National Health Service. Below are two contrasting letters about a patient that could have been written from a hospital psychiatric service to a patient’s GP following the patient’s first attendance at a psychiatric clinic. These are based on a real patient’s story, but the letters are both written by GP, David Zigmond to bring to life two very different ways of understanding the patient’s problems. The text of the letters appear in his article, Language is not just data: it is custodian of our humanity.

David Zigmond asks this question under the two letters:

“If it were you that was distressed, which doctor would you wish to tend to you?“ He ends his article with this paragraph:

Archimedes’ notion of displacement is instructive far beyond the physical world: it often operates in the realms of human culture and language. The overgrowth of the technical and the schematic can all too easily – without malign design – extinguish the organic and the human. Our world of ever-increasing mass-production has many hidden taxes. There are hungry conundrae, too: how do we safeguard literature in our language, art in our (medical) science and heart in our practice?

Zigmond has used his expressive language to clarify the challenge we face. We must find ways of exploiting the wonders of bio-science with our analytic faculties, but without sacrificing the holistic approach that requires our imaginative and creative side. Currently, much of the time we are using only one side of our brain.

One of the conundrae here is that medical practice is reliant on the story told by the patient. Interpreting this story can be done in a narrowly medical way: looking for patterns that match the pattern of a diagnosis carried within the doctor’s mind. Or it can be done like reading a book or a poem. This is a different kind of interpretation in which the ‘reader’ and the ‘text’ co-create meaning. This meaning might include a possible diagnosis, but if the clinician is in interpretive mode, there will be much more besides the disease category or ‘label’.

…a diagnostic label is the goal, and often the price of an interpretive understanding in medicine.
Kathryn Montgomery Hunter in Doctor’s Stories.

This quotation suggests that needing to arrive at a diagnosis risks diminishing the wider understanding. The category gets in the way of the deeper meaning. It is the balance between these two that we are seeking. Without that balance, we have a reductionist understanding, a poverty of knowing the person and therefore of his or her illness .

The following quotation from GP, David Zigmond, describes how the healthcare system organises itself around the diagnostic categories:

Providers’ now spawn ‘treatment packages’. Fascinatingly kaleidoscopic forms of difficulty and distress are speedily designated to ‘mental illnesses’ or ‘disorders’, and hence streamed to the ‘appropriate intervention’. There is no language (or time) here for the ambiguous, the nascent, the naturally evolving; the semiotics of symptoms, the creative possibilities of uncertainty. The language is systolic.

And then the language determines the thinking.

The monoculture language, intended to expedite the functions of system and symptom management, does not merely provide utilitarian thoroughfare. Like tarmac roads, such prevailing or exclusive language destroys other forms of intellectual life or thought. An unmitigated use of psychiatric or organisational language will, for example, lead to reification; an unwittingly obstructive consequence of language. Mental illness becomes a ‘thing’, akin to a Cataract or Inguinal Hernia.

David Zigmond   No Country for Old Men in  If you want good personal healthcare, See a Vet

 

In the end, we need to decide who should have priority here: the system or the person? (patient and practitioner). The current language strongly suggests that it is not the people who are operating the system for the people’s benefit; but rather the system is operating the people for the system’s benefit. If we think this is the wrong way to run a health service, we are duty-bound to do something about it.

 

The Dimensions of Being Holistic

Why Now?

There is now public and professional unrest within the UK National Health Service. This provides a potential constituency of supporters for change. For this we need a message of hope for those many who have received poor or unfeeling medical care, and for those many practitioners who are disillusioned with the ways of working imposed upon them in the NHS. Whilst wonderful work is still being done by those who manage to defy the system, there is widespread and deep unhappiness with contemporary healthcare. In recent years, this is seen through public outcries over cruel and degrading care of older people in hospitals and care homes and in mental health facilities; in never seeing the same doctor; in becoming lost in impersonal bureaucratic systems.

Over the last 2-3 years a large and growing medical grass roots movement has come together against overdiagnosis and overtreatment. This amounts to medicalisation of life’s travails under the guise of Evidence Based Medicine. The current junior doctors’ industrial dispute in 2016, though ostensibly about pay and hours of work, is fueled by the mutation of professional practice into a managerial process heavily moulded by political imperative. The resulting role ambiguity and relentless pressure are highly stressful. Finally, the perennial problem of waiting lists – the inability of the NHS to meet demand and the stress that this creates – is to a large degree ‘failure demand’. This means demand for care arising from previous failure to recognise and respond to the underlying problems, especially at a social and economic level. The roots of illness are in society.

The Response

“The real voyage of discovery consists not in seeking new landscapes but in having new eyes.”                                  

                                                                                                                                         Marcel Proust     

Proust urges us to have new eyes, so we can see what is before us in new ways. But how do we go about this? The fact is that we are not always good at seeing what is before us. Before Proust wrote about the recovery of memory from tasting a childhood cake few had noticed this human capacity. Before Wordsworth’s poems, the Lake District in the North West of the UK was a poor and hilly farming district of no particular interest. Now we see the beauty of simplicity.

Before Vincent van Gough’s paintings of poor farmers digging, cafés, chairs, sunflowers, we did not see these things in the way we do now. He showed us the dignity of simplicity.

Perception is heavily influenced by what we expect to find and what we have the language to express. So perhaps, by reminding people of language which is lost or forgotten, our new eyes will lead us to Proust’s ‘real voyage of discovery’.

 

So we build our strategy for transformation on language and image.

 

 

 

We found that the twelve largest words emerged to provide us with the dimensions of being holistic.

 

These are all natural human qualities. We all have the potential for each, but none will be equally good at all. This is not about being perfect, there is no perfect in humanity.

“Out of the crooked timber of humanity, no straight thing was ever made.”         

Immanuel Kant

So we must forgive ourselves and others for being crooked. We must be compassionate. Every generation has its challenges in this respect. Ours, here, is to cope with the manifold effects of science and technology, of harnessing the power of the natural world in ways that are wise, where in foolish hands, great damage might be caused.

“A virtuous, ordinary life, striving for wisdom but never far from folly, is achievement enough.”        

Michel de Montaigne

What is most vulnerable and must be protected is like a seed in the breeze, fragile and transient but full of promise. The essence of this fragility and of human knowing is predominantly about ourselves. Without being self-knowing and self-caring we have little hope of caring for others and the world. Much of this is about feeling part of something much bigger than us. If we can achieve this, then caring for ourselves, for others and for our wonderful planet will come to us naturally. This is being community-minded.

[People] “…are free when they belong to a living, organic, believing community, active in fulfilling some unfulfilled, perhaps unrealized purpose.”         DH Lawrence

So to be free, we must belong; and to belong is to be empowered.

“There is no more powerful way to initiate significant change than to convene a conversation. When a community of people discovers that they share a concern, change begins. There is no power equal to a community discovering what it cares about.”   Margaret Wheatley

resilient. There is no perfect because the energy of the world derives from change, from tension between opposites. All is change, like the leaf in a tumbling stream, fragility riding the waves of power; once beautiful, now buffeted about on an invisible shifting film of surface tension, buoyed up by air, held down by gravity. Change and agility gives us both resilience and sustainability. Just try riding a bicycle without moving the handlebars! Change also gives us stories, perhaps the most potent way of grasping our evolving reality.

Humans have a peculiar need to find meaning in all this. Meaning is the tenuous, evanescent light that draws us onward in the story of our lives; the light that if we look too hard or try to analyse, is liable to go out.

 “There is a light in my heart but when I try to look at it with my intellect, it goes out.”        Friedrich Jacobi

We are grateful when it flickers on and saves us from darkness. We search for a medicine of meaning.

Our shifting world, unknowable entirely, in unimaginable space, giving glimpses of itself as much to our intuitive sense as to our analytic mind.

“If we could get the hang of it entirely

It would take too long;

All we know is the splash of words in passing

and falling twigs of song,

And when we try to eavesdrop on the great Presences it is rarely

That by a stroke of luck we can appropriate

Even a phrase entirely.”

        from  Entirely by Louis MacNeice

Our meaning must come from being integrated:  making sense of these glimpses as best we can, often by a story; living with uncertainty but aiming for coherence and resonance in a life of enquiry: being balanced.

Perhaps being connected is the most essential of our natural human qualities. But too often we are lonely. This may be from being alone, but more often it is our difficulty in making meaningful connection with another sentient being.

“Loneliness does not come from having no people around you, but from being unable to communicate the things that seem important to you.”         

Carl Jung

So much of the modern doctor’s time is taken up with patients whose problems can be reframed as loneliness of the soul – of the inner being – manifesting in diverse ways, from serious physical illness to unhappiness and lack of fulfillment. Perhaps this is the malady of our times. Of course, with an holistic view, we know that this loneliness of the soul goes deeper. Here is Jung again.

“If things go wrong in the world, this is because something is wrong with the individual, because something is wrong with me. Therefore, if I am sensible, I shall put myself right first.”     

Carl Jung

This is an echo of John Donne’s famous lines, their fame perhaps residing in their truth, their resonance with the depth of the human soul. That we do not, for the most part, practise this wisdom is another demonstration of our crooked timber, yet it contains the promise of better times for mankind. Before we can start building these better times, we must first have the new eyes recommended by Proust and which are promised to those with holistic vision.

“No man is an island entire of itself; ……any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.”          John Donne

 

Holistic – discover

The Human Qualities of Being Holistic:

1. Compassionate – to yourself and others;
2. Wise – practising the exercise of judgment leads to knowing when to trust yourself (and when you need help);
3. Self-caring – if you do not care for yourself you cannot care for others (put your oxygen mask on first!);
4. Community-minded – the community is the source of health (when unhealthy it requires yourhelp);
5. Empowered – through being with and working with others; we are all feeble on our own;
6. Resilient – by being flexible, adaptable, agile and alert in your ways of being;
7. Meaningful – being aware that we humans all need meaning in our lives; you can help others to find meaning;
8. Intuitive – knowing we have inside us faculties that are mysterious and wonderful;
9. Integrated – in a fragmented society we must find ways of making sense of complexity;
10. Balanced – if you are lopsided you are more likely to fall over, or riding a bicycle means moving the handlebars;
11. Connected – we are all part-of one another, nature, the world; being part-of entails being responsible-for.

This is not about perfection

– we are all crooked timber.

                     It is about openness to ourselves and others.

Holistic – take action

12 ways to be more holistic

1. Learn to listen
2. Learn to ask questions without fear of ridicule (if something sounds wrong to you, it probably is)
3. Look for experiences outside your field of work
4. Read and study disciplines outside your field of work
5. Mix with people who inspire you (even if you disagree with them)
6. Make things with your hands
7. Study yourself; write about yourself (look for the artist within and embrace imperfection)
8. Accept change as inevitable (but look for its root causes)
9. Admit mistakes
10. Smile (there’s humour in every predicament)
11. Understand that we belong to nature  (not the other way round)
12. Know that love is the fuel of human life